Category: #COT2017

It’s always great to come together at the end of conference rather than all drifting off homeward and boy was this a session worth coming together for.

A session which informed, provoked thought, was full of humour and ended with the usual video roundup of photos you may have wished you knew were being taken at the time.

Jennifer Creek started the session by taking us on a journey from the origins of our profession to present day proposing that we should pay more attention to practice that is happening on the margins if we want to seek answers to some of the major challenges we face currently. It really challenged by thinking about what how power is invested in the centre and the influence this power exerts on a profession and the way it practices.

I had never really thought about the relationship between the origins of our profession and the rise in women’s movement from the late 19th century onwards but of course it made sense. How the liberation of women from the home and the domestic roles they had been cast in previously opened the door for them to take on wider more influential roles and responsibilities within society. Education, housing, contributing to the war effort and supporting those marginalised within society all became a focus of their work. Women started moving into professions where they had greater influence and ability to effect change.

Jennifer traced this journey across the Atlantic to the founding of the first school of occupational therapy and back to the origins of occupational therapy in the UK. It is of course always important to be reminded of our history but Jennifer’s journeying didn’t stop there.

Rather than this closing plenary being a lesson in our history we were taken one step further a step which felt a little less comfortable as Jennifer explored how thinking and practice in the USA and UK began to colonise our practice on a global level and dominate the centre ground of occupational therapy practice. Perhaps sharing her definition of margin may help illustrate this:

a physical place, a social space or a personal experience on the periphery of the social mainstream or dominant order. For every margin there is a core that represents some form or position of authority, power and privilege.

Jennifer shared how her experiences in South Africa had provided her with an opportunity to witness the resourcefulness, innovation and expertise that are occurring when you move further away from the constraints of the centre ground. She explored some of the characteristics of working at the margins – summarised on the slide below

Having worked in a small voluntary sector user led organisation in the late 1980s where funding was always an issue, the organisation was transitioning to becoming user led at the height of the rise of the disability movement and we were seeking new responses to meet demand – these all sound familiar. Exciting, challenging, liberating and scary are all be words I would use to describe that time.

Jennifer’s call: Explore the margins, places and spaces away from the mainstream if you want to discover places where creativity happens. This resented strongly with me.

Tina Coldham. Chair of the Social Care Institute for Excellence (SCIE) Co-Production Network, SCIE Trustee and Mental Health Campaigner

Last night an OT Saved my Life

Well, what can I say – I’m not even going to try to summarise Tina’s presentation for you as I know I won’t do it justice. There are some great moment captured on twitter for you to explore – just explore the hashtag #COT2017.  You really did need to be in the room to experience the heartfelt, side splittingly funny way in which Tina talked about the impact of occupational therapy on her life.

Describing herself as, “a practicing depressive – because I’m still practicing!” and through all the laughter, banter and jokes there was a serious message as Tina reflected on the different ways in which her encounters with occupational therapists have supported her at different times in her life. She talked about what it meant to have someone who was interested in her rather than her diagnosis. How no area of discussion was out of bounds.

Perhaps it is enough to leave you wth Tina’s description of occupational therapy as ‘the art of the possible rather than the science of the impossible.’

If you didn’t make it to conference I really want to flag up that Tina will be hosting one of the weekly #OTalk researchers on co-creation in research. Watch this space because I just need to pin them down to a date but it will be the 1st Tuesday of the months some time in the future!

What a fitting note to end conference on – but then of course came the photos!

Written by @lynnegoodacre

 

Poster P54
Bridging the gap between inpatient and community within a forensic learning disability service. Smalley L: Southern Health NHS Foundation Trust

Reference: Vona du Toit Model of Creative Ability Foundation UK .. 2017 .. What is the Vona du Toit Model of Creative Ability? (Online). Available at: http://www.vdtmocaf-uk.com/page/what-i s- the-vdt-moca [Accessed 12th June 2017]

Contact Email Address: L.Smalley@NHS.net

Blog shot by @Helen_OTUK

Poster P81: Participation in advanced age: enacting values, an adaptive process
Sugarhood P: London South Bank University

References: Sugarhood, P., Eakin, P., Summerfield-Mann, L. (2016).
Participation in advanced older age: enacting values, an
adaptive process. Ageing and Society, Jun 20. doi: 10.1017/
S0144686X16000568.

Contact Email Address: p.sugarhood@lsbu.ac.uk

Blog Shot by @Helen_OTUK

Contact Email Address: samantha.fordham@nhs.net, becky.glassman@nhs.net

Blog Shot by @Helen_OTUK

After a whirlwind two days the conference was almost over. This was the last session I would attend before the closing plenary and my mind was already buzzing with thoughts from other sessions I had seen. I wondered if I had made a mistake signing myself up to cover a session so close to the end of the conference. However, when Kathryn Jarvis sprung into life on stage I knew it was going to be an engaging and thought provoking session…

Implementing constraint induced movement therapy: a mixed methods study

Kathryn provided a simple outline of constraint induced movement therapy (CIMT);

A complex intervention to increase upper limb function, usually post stroke, made up of two components:

1. Constraint of the less affected upper limb with a mitt or sling.
2. Intense training of the affected limb.

She then relayed a story of a “bouncy” consultant who had heard about CIMT and with enthusiasm had asked – why aren’t we doing it? This question has stayed with Kathryn and prompted her to think critically about the evidence base for CIMT, and start her own research in to the area.

CIMT is not widely used in practice, and where it is practiced we are not using existing evidence based protocols. Kathryn’s mixed methods design used both quantitative outcome measures and qualitative interview to capture the impact of CIMT for four participants. For me, one of the most interesting aspects of Kathryn’s presentation of this research was her acknowledgement that where she expected to see the most gains in terms of performance (and there were improvements in performance for all four participants, some more marked than others), the biggest observable benefits of the CIMT protocols were in areas of volition and habituation. Kathryn thinks that “mixed methods ROCK” because had they not been using qualitative methods alongside the quantitative outcome measures, this aspect would not have been captured in the research.

What Kathryn’s research reveals is that evidence based protocols for CIMT are feasible for patients, with patient’s benefiting from a protocol that involves 3 hours training and 3 hours constraint. Feasibility in practice is not necessarily the same, the intensity of the training requires huge investment of time from staff and the trust where this research was carried out are still not implementing this protocol. Kathryn also highlighted that we still do not know what the active ingredients of CIMT are – we know the core components are training, constraint, routine, hope and the role of the therapist, but which elements are producing the outcomes? Complex interventions require a complex web of research.

Application of a conceptual framework to facilitate return to paid work following a brain injury

Karen Beaulieu has over thirty years experience as an occupational therapist working with patients who have had a brain injury. Both her own experience and the existing literature highlighted to her that returning to work is often a high priority for those who have experienced a brain injury, however a return to sustained paid employment is very difficult. Karen has conducted qualitative phenomenological research with 16 brain injury patients who have returned to work, and 11 employers who have been involved in this process, to explore how we as occupational therapists can begin to better facilitate this priority goal for our patients.

Karen acknowledged the short window of time she had to discuss this complex piece of research, and discussed her plans to take this research project forward. In the mean time, though she wants to be sharing the conceptual framework she has devised from her research and urges us to think about applying it. The four key themes of facilitating factors that came out of her research were occupational needs (including neglected areas such as drive and engagement), experiencing loss, grief and adjustment, looking at self identity (How are they different? What anchors them to their former selves?), and the importance of social inclusion and understanding in returning to work. These themes then lead to the conceptual framework below:

Karen urged all those who work with brain injury patients to be thinking about the elements outlined in the framework much earlier than usual, starting this process of managing expectations and addressing the grief from the beginning of a patient’s rehabilitation. I really look forward to seeing how this framework develops and hearing more of Karen’s findings in this area.

By Ayla Greenwood, @AylaOT